Ecuador

During July and August of 2014, one of Minga’s Board members, Karin Friederic (who is also an Assistant Professor of Anthropology at Wake Forest University), traveled to Minga’s project site in Ecuador with two of her students, Ty Kraniak and Bennett Heine. While Dr. Friederic conducted pilot research for her current project and intervention on family relations and intimate partner violence, Ty investigated the effects of the SaludCom project and Bennett lent his support by improving health center facilities, painting the community library, and developing health education materials.Together they participated in medical brigades with health center staff, took jungle treks, swam in beautiful waterfalls at the Bilsa Biological Station, and they learned survivalist cooking techniques, like making rice in bamboo stalks and plantain patties over open fires. Above all, they partnered with local friends and colleagues to improve community health and healthcare through plenty of hard work and laughter.

Here’s one of Karin’s stories from the field:

The generator kept going out. The lights flickered and the machinery whirred. My student, Ty, stepped in with an array of headlamps and flashlights to help the dentist, Thamar, as she continued to clean teeth and treat cavities with her manual tools. She could still see, thankfully, but with two more patients waiting, this now meant at least another hour of work, not twenty minutes. We couldn’t send the patients home—they lived an hour away and had waited all day to be seen. While important, these rural medical brigades (when health center staff travel to a remote community for 2-3 days to provide medical care and health education) were never quite enough. As workers in global health and development already know, administering health care in rural Ecuador is different than health care in the United States. For one, in the U.S. we can depend on a certain level of basic infrastructure (i.e. stable electricity, newer equipment, paved roads). However, in many parts of the world, people are meeting these challenges by prioritizing particular kinds of infrastructure and technology and adapting them to better serve diverse needs and contexts across the globe.

To this end, in 2010 the Minga Foundation partnered with NOKIA to understand how mobile cell phones could be used to improve health communication and responsiveness to local illnesses and emergencies. For example, rather than installing landline telephones and electricity lines, one community in rural Ecuador utilizes cell phones and solar panels for communication and electricity. However, despite widespread success, every project has its hiccups—a truth that, at the very least, always keeps us on our toes. There aren’t enough cell phone towers to provide consistent coverage to these rural areas, and despite early promises from cell phone operators in Ecuador, they lost interest in the project. So, while our health promoters and health committee members benefitted from having quality cell phones, many still had to walk 30 minutes to the top of a ridge or a particular tree to get cell signal. As a medical anthropologist who helps develop health programming in rural Ecuadorian communities, I am consistently trying to take advantage of technology’s benefits (often touted as the simple answer to under-development), while simultaneously developing flexible and adaptive contingency plans; as we have seen time-and-time again in development projects worldwide and in the United States, tech fixes are never enough.

Thus, as part of the SaludCom Project in Ecuador (2010-2014), we’ve been integrating technology with common-sense and culturally appropriate approaches to communication. We’ve given out cell phones and installed booster antennas, but we’re also using additional less-sexy platforms: printed flyers and face-to-face communication. In this region, people have varying access to technology and they live in remote locations (up to ten hours away from the health center); therefore, it is crucial that people receive messages about health center hours, availability of doctors, medical emergencies, health related meetings, and health promotion activities. NOKIA stepped in wanting to provide a silver bullet that would allow us to skip paper and face-to-face interaction. While that approach may have been more efficient in theory, experience on the ground called for complementary strategies to be effective. Our friends in Ecuador demanded that, and guided us to recognize that. Just as Thamar and Ty adapted to electricity shortages by using alternative tools on hand, Minga has been working in close partnership with community members and continually retooling our strategies to make sure that what we do, we do well, even if it takes us a few extra steps. I repeatedly tell my students that the ideas informing the work of global health and development should never emerge “fully cooked” in board room meetings, annual retreats, or even classrooms. Implementing ideas in deep partnership with communities and in radically distinct contexts can be humbling, frustrating, and slow, but after fourteen years of experience, this is the work that sticks. Please share ideas and experiences if you’d like and, as always, I invite you to Minga with Us.

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